Rationing of NHS services and drugs is 'inevitable'

The debate over NHS funding erupted again today after a British Medical Association (BMA) report warned that increased public funding alone would never solve the problems of the health service.

The report says the concept of the NHS as a service that can offer all treatments may have "outlived its usefulness" and that rationing of services and drugs was inevitable.

Both the public and the government would have to accept that new and expensive treatments would in the future be limited to those who could pay for them privately, it said.

The government welcomed the report, pointing out that its endorsement of a tax-funded NHS and its rejection of private health insurance systems reflected the government's own beliefs.

The report comes less than a week after NHS managers warned that health authorities and trusts were struggling to balance their budgets for the next financial year, despite the extra billions earmarked for the service last year.

Last March, chancellor Gordon Brown announced a 6.1% average annual real terms increase for the NHS, worth around £19bn over four years, a move dubbed the biggest ever increase in health service history.

The BMA report says rationing of medicines and therapies in the health service is more attractive than alternative ways of funding the NHS, such as a dedicated health tax or charges for specific services such as GP appointments.

It also warns that patients will continue to suffer unless ministers and voters "faced up" to the idea of NHS rationing.

A BMA steering group spent a year producing its Healthcare Funding Review, based on public opinion polls, written evidence from health experts and surveys of evidence on healthcare policy.

It found that while people distrusted the way healthcare rationing was occurring in a concealed manner in the NHS, there was equal "distaste" for the prospect of an explicit limiting of specified services.

The review gave cautious support to the government's NHS plan, published last July, welcoming the extra investment but warning that improvements could take years to become evident.

BMA chairman Dr Ian Bogle, who headed the steering group, said: "We have looked at other methods of funding healthcare, but these can never resolve the rationing dilemma.

"Whatever funding method we adopt and however much money we spend on healthcare, we always reach a point at which the cost of treatment begins to outweigh the benefits.

"We have to accept the prospect of treatments being excluded from the NHS if we want to maintain a universal service, one which is available to everyone and essentially free at the point of use."

The report concludes: "The concept of the NHS as a comprehensive service may have outlived its usefulness.

"It will be increasingly commonplace to see treatments which are judged to be of limited clinical effectiveness, not cost-effective or an inappropriate use of public funds, excluded from this system."